title: The history of barbed sutures.
abstract: Ligatures have been used for millennia to close wounds. Sterilization and synthetic polymers that degrade in a commensurate fashion with wound healing have been the most significant improvements in these age-old devices. However, the constricting loop of a traditional suture and subsequent ischemia ("approximate, don't strangulate") still account for the most common cause of wound dehiscence-necrosis. Inspired by the quill of the North American porcupine, I envisioned a bidirectional array of barbs that could secure tissue without relying on constricting loops. One set of barbs could anchor the other. In this article, I document the development process of these barbed sutures from concept to patent to manufacture and US Food and Drug Administration approval. Knotless, strong, and easy to place, barbed sutures could foreseeably supplant conventional sutures, particularly as endoscopic procedures become more common. They also offer the intriguing potential to suspend ptotic tissues without surgical intervention.
authors.affiliation: Dr Ruff is a plastic surgeon in private practice in Chapel Hill, North Carolina.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Ruff
mesh_terms: D003357:Cosmetic Techniques / Q000266:history; D018795:Device Approval; D004059:Diffusion of Innovation; D004867:Equipment Design; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D010330:Patents as Topic; D019651:Plastic Surgery Procedures / Q000266:history; D012060:Rejuvenation; D013536:Suture Techniques / Q000266:history* / Q000295:instrumentation; D013537:Sutures / Q000266:history*
keywords: barbed sutures; bidirectional; knotless; loops; minimally invasive; self-anchoring; transition zone